Obesity in People with Learning Disabilities: the impact of nurse led health screenings and health promotion activities

Background. Obesity appears to be more common among people with intellectual disabilities, with few studies focusing on achieving weight reduction. Aim. Firstly, to follow up people identified as overweight and obese following special health screening clinics and to determine the actions taken. Secondly, to evaluate the impact of health promotion classes on participants' weight loss. Methods. A clinic led by two learning disbaility nurses was held for all people aged 10 years and over (n=464) who attended special services within the area of one Health and Social Services Trust in Northern Ireland. In a second study, the nurses organised health promotion classes for 20 people over a 6 - 8 week period. Findings. The health screen identified 64% of adults and 26% of 10 - 19 year olds as being overweight or obese. Moreover, those aged 40 - 49 years who were obese had significantly higher levels of blood pressure. However, information obtained from a follow up questionnaire sent after 3 months suggested that of the 122 people identified for wiehgt reduciton, action had been taken for only 34% of them and only three were reported to have lost weight. The health promotion classes, however, led to a significant reduction in weight and body mass index scores. Conclusion. Health screening per se has limited impact on reducing obesity levels in this client group. Rather, health personnel such as general practitioners, nurses and health promotion staff need to work in partnership with service staff, carers and people with intellectual disabiltieis to create more active lifestyles.

Changes in the attitudes of GPs to health screening of patients with learning disabilities

GP's appear reluctant to undertake health screening for people with learning disabilities. This article describes a specialist health screening service delivered mainly by community learning disability nurses to nearly 600 children and adults. Prior to the service being established, 141 GPs within a defined area were surveyed and 51% responded. Although a majority thought the service would be helpful, three-quarters felt it was better provided within the context of specialist services. After screening, 54% of the sample (318 persons) were referred to their GP for further assessment and treatment, nearly all for physoical health needs. A second study investigated the attitudes of 91 GPs who had patients refrrered. Those (45) who reported dealing with a referral were more favourably disposed to undertaking health screening within their practice, whereas those (23) who had been uninvolved continued to opt for specialist provision. Options for encouraging more GPs' to offer preventive health care to theisclient group are discussed, including medical training, extra consulting time and linking community learning disbaility nurses with GP practices.

Compression therapy in leg ulcer management

Led ulcer management is an important consideration for all nurses involved in the care of older people. Non-specialists in tissue viability might not always be aware of the evidence base for best practice. The authors examine the effectiveness of multi-layer and single-layer long or short stretch bandage systems in leg ulcer management.

Skin-to-Skin contact

Skin to skin contact facilitates the initiation of breast feeding, neonatal thermoregulation and the promotion of maternal-infant attachment. However, there are cultural influences in society and in the labour ward that may make implemention of skin to skin contact difficult.

Providing a healthcare input to children in special schools

The education of children with speical educational needs is often accompanied by a requirement for medical or healthcare provision. If this cannot be done safely then the child's access to education may be limited. No standardised template for the delivery of a healthacre input to children in special schools is apparent. This study sought to explore through the use of an indepth needs assessment exercise and focus group interviews, what the most appropriate healthcare roelewas for delivering heathcare in a special school catering for children with a broad range of severe learning disabilities. While an overwhelming viewpoint of participants in focus gorups perceived that a nurse was the only suitable person to undertake the role, the evidence gathered promoted the research steering group to suggest to the contrary, i.e. that the role of a healthcare with a national vocational qualification (NVQ) level 3 in care was more the appropriate person to maximise both the role of the nurse and the quality of care provided to these children.

Modeling energy consumption in error-prone IEEE 802.11-based wireless ad-hoc networks

In the IEEE 802.11 MAC layer protocol, there are different trade-off points between the number of nodes competing for the medium and the network capacity provided to them. There is also a trade-off between the wireless channel condition during the transmission period and the energy consumption of the nodes. Current approaches at modeling energy consumption in 802.11 based networks do not consider the influence of the channel condition on all types of frames (control and data) in the WLAN. Nor do they consider the effect on the different MAC and PHY schemes that can occur in 802.11 networks. In this paper, we investigate energy consumption corresponding to the number of competing nodes in IEEE 802.11's MAC and PHY layers in error-prone wireless channel conditions, and present a new energy consumption model. Analysis of the power consumed by each type of MAC and PHY over different bit error rates shows that the parameters in these layers play a critical role in determining the overall energy consumption of the ad-hoc network. The goal of this research is not only to compare the energy consumption using exact formulae in saturated IEEE 802.11-based DCF networks under varying numbers of competing nodes, but also, as the results show, to demonstrate that channel errors have a significant impact on the energy consumption.

A Novel Packet Marking Function for Real-Time Interactive MPEG-4 Video Applications in a Differentiated Services Network

The future convergence of voice, video and data applications on the Internet requires that next generation technology provides bandwidth and delay guarantees. Current technology trends are moving towards scalable aggregate-based systems where applications are grouped together and guarantees are provided at the aggregate level only. This solution alone is not enough for interactive video applications with sub-second delay bounds. This paper introduces a novel packet marking scheme that controls the end-to-end delay of an individual flow as it traverses a network enabled to supply aggregate- granularity Quality of Service (QoS). IPv6 Hop-by-Hop extension header fields are used to track the packet delay encountered at each network node and autonomous decisions are made on the best queuing strategy to employ. The results of network simulations are presented and it is shown that when the proposed mechanism is employed the requested delay bound is met with a 20% reduction in resource reservation and no packet loss in the network.

SLA-driven flexible bandwidth reservation negotiation schemes for QoS aware IP networks

We present a generic Service Level Agreement (SLA)-driven service provisioning architecture, which enables dynamic and flexible bandwidth reservation schemes on a per-user or a per-application basis. Various session level SLA negotiation schemes involving bandwidth allocation, service start time and service duration parameters are introduced and analysed. The results show that these negotiation schemes can be utilised for the benefits of both end user and network provide such as getting the highest individual SLA optimisation in terms of Quality of Service (QoS) and price. A prototype based on an industrial agent platform has also been built to demonstrate the negotiation scenario and this is presented and discussed.